Services for the Arab Elderly in Israel

As the author himself writes, the professional literature pertaining to family and aging in the Arab society both in Israel and in its neighboring countries is meager. Dr.

Faisal Azaiza of the Faculty of Social Welfare and Health Studies has been trying to fill some of the large gaps. In this article, excerpted from his article in the Journal of Gerontological Social Work, he charts changes and developments based on published statistics and personal observations.

Although the model of family relations among the elderly rural Arabs as it exists today in Israel is in a sense similar to the traditional model described in the literature, various aspects of it do differ. These relations are no longer based on multi-generational extended households, comprising the father, all his married sons, and their offspring; nor is it a limited two-generational household—the parents and one married son with his family. It is based, in fact, on a ramified familial structure, typified by a number of households located close to one another. This study explores the changes presently occurring in the Arab family, especially those that have a direct influence on the elderly living within the family circle.

The roots of tradition, strongly embedded in inter-generational relationships, are expressed, for example, in the differences between the sexes with respect to involvement in familial and economic decision-making. On the other hand, the changes occurring in the Arab society are evident in this domain: in nearly half the households, women—mainly those who have acquired education to a smaller or larger extent—now actively participate in decisions regarding pivotal familial issues. In addition, educated young professionals, returning to their villages of birth, serve as powerful “agents of change.” Indeed, they are shaking the very foundations of the traditional structure of Arab society, in which the elder, as the incontestable head of the extended family, was in absolute command.

The Arab population in Israel in 1992 counted 3.1% over the age of 65, compared to 11% of the Jewish population in this category. On the other hand, the percentage of frail Arab elderly community-dwellers restricted in their daily activities amounts to 22.1%, compared with 9% among the senior Jewish population. The number of older Arab frail persons is expected to triple that of their Jewish counterparts.

Attempts at establishing and developing social services in the Arab sector in the past have been beset with difficulties. A prime factor was the attitude of the elderly themselves and of their families toward the formal services offered by the municipality or the state or other official bodies. According to Arab tradition, the responsibility for the care of the old rests with the family, making this informal support system an extremely broadly ramified familial network.

A further cause of reservations about the system of formal services is the negative experiences of the past, sometimes because of the long waiting time for a service that did not materialize, at other times because it was not suited to the needs of the senior citizen. The lack of awareness regarding the support systems focusing on the needs of the Arab senior citizen led to a relative backwardness in the development of such services in this sector, which in turn contributed to a lack of understanding on the part of the elderly and their families regarding the benefits of such services.

Professional field workers report that the 1988 Community Care Law helped increase the awareness of the needs of the elderly, their problem, and their rights in both the family circle and the local support system. The law, though, was not readily accepted by traditional Arab circles, which objected to strange caregivers in their home. The welfare agencies hit upon a solution: allow the grandchildren (or other close relatives) to take care of their grandparent(s). The rate of Arab pensioners receiving home care aid under the law amounts (in 1991) to 11,8%, which is higher than among the Jewish elderly beneficiaries.

The older and old villagers used to spend most of their time in the divan (lit. council), a social meeting place akin to a club. These nearly entirely disappeared in the wake of modernization. To date, about ten years after the inception of senior citizen clubs to replace the divans, there exist about 50 such facilities catering to 11% of the older Arab population in the Arab villages. In addition, about 5% of the Arab elderly in Israel attend a senior citizen day center. A surprising development is that although the frail and disabled elderly still constitute the majority, an increasing number of independent elder persons also visit these centers.

The rate of institutionalization among the Arab population has always been low. Until the establishment of the nursing home in Daburriyah, a village in the Galilee, in 1993, there had been only one small retirement facility (for 30 women, in Nazareth). Two thirds of the residents of the nursing home were community dwellers, the remaining coming directly from a hospital after a critical illness.

The opposition of the elderly in the Arab village changed for the good and the bad at the same time. They benefit from modern medical treatment, but their social status has deteriorated; the elderly individual is no longer the prominent figure whose authority is unchallenged and who determines everything regarding family matters.

The classic extended multi-generational household has disappeared from Arab life in Israel; however, familial support and the formal social infrastructure that has been set up in the Arab villages enable those of advanced age to remain living in the community. The retirement home is largely populated by single persons in a nonfunctional state of health, whose care is beyond the capabilities of the family.

Because the old familial system is disintegrating, we are witnessing the development of formal services for the Arab elderly. The clubs that have been established in various villages came into being because of the professionals among them, with their modern education, and the readiness of the elderly themselves, who felt lost in the new atmosphere. Initially the clubs were purely social; later the need arose for more extended services, such as individual treatment for the frail, including warm meals. Then came requests for day care centers, and now there are six such centers. In the third phase, a nursing home for the aged was established.

On the face of it, people are more than willing to utilize geriatric services. Nevertheless, each newly introduced component is approached with suspicion and ambivalent feelings on the part of the Arab public. Some professionals in the geriatric field are convinced that the formal services will inflict harm upon the delicate intergenerational structure. It is therefore imperative to keep to the golden rule of fine balance when developing new services: on the one hand, not to discharge the family from all responsibilities toward the old family member; on the other, not to leave an elderly person who is not properly cared for or even neglected by his family in these surroundings under the guise of tradition. In other words, to walk the fine line between formal and informal services.